Are you encouraging your child to get into accidents or even blind when growing up?

Erik Peper and Meir Schneider

As a young child I laid on the couch and I read one book after the other.  Hours would pass as I was drawn into the stories. By the age of 12 I was so nearsighted that I had need to wear glasses.  When my son started to learn to read, I asked him to look away at the far distance after reading a page. Even today at age 34, he continues this habit of looking away for a moment at the distance after reading or writing a page.  He is a voracious reader and a novelist of speculative fiction. His vision is perfect. –Erik Peper

How come people in preliterate, hunting and gatherer, and agricultural societies tend to have better vision and very low rates of nearsightedness (Cordain et al, 2003)? The same appear true for people today who spent much of their childhood outdoors as compared to those who predominantly stay indoors. On the other hand, how come 85% of teenagers in Singapore are myopic (neasighted) and how come in the United States myopia rate have increased for children from 25% in the 1970s to 42% in 2000s (Bressler, 2020; Min, 2019)? 

Why should you worry that your child may become nearsighted since it is easy correct with contacts or glasses?   Sadly, in numerous cases, children with compromised vision and who have difficulty reading the blackboard may be labeled disruptive or having learning disability. The vision problems can only be corrected if the parents are aware of the vision problem (see https://www.covd.org/page/symptoms for symptoms that may be related to vision problems). In addition, glasses may be stigmatizing and  children may not want to wear glasses because of vanity or the fear of being bullied.

The recent epidemic of near sightedness is paritally a result of disrespecting our evolutionary survival patterns that allowed us to survive and thrive. Throughout human history, people continuously alternated by looking nearby and at the distance.  When looking up close, the extraocular muscles contract to converge the eyes and the ciliary muscles around the lens contract to increase the curvature of the lens so that the scene is in focus on the retina — this muscle tension creates near visual stress.

The shift from alternating between far and near vision to predominantly near vision and immobility

Figure 2. The traditional culture of Hdzabe men in Tanzania returning from a hunt. Notice how upright they walk and look at the far distance as compared to young people today who slouch and look predominantly  at nearby screens.

Experience the effect of near visual stress. 

Bring your arm in front of you and point your thumb up.  Look at your thumb on the stretched out arm.  Keep focusing on the thumb and slow bring the thumb four inches from your nose.  Keep focusing on the thumb for a half minute.  Drop the arm to the side, and look outside at the far distance.

What did you experience? Almost everyone reports feeling tension in the eyes and a sense of pressure inside around and behind their eyes.  When looking at the distance, the tension slowly dissipates.  For some the tension is released immediately while for others it may take many minutes before the tension disappears especially if one is older. Many adults experience that after working at the computer, their distant vision is more fuzzy and that it takes a while to return to normal clarity.

When the eyes focus at the distance, the ciliary muscles around lens relaxes so that the lens can flatten and the extra ocular muscles relax so that the eyes can diverge and objects in the distance are in focus.  Healthy vision is the alternation between near and far focus– an automatic process by which the muscles of the eyes tightening and relax/regenerate.

Use develops structure and structure limits use

If we predominantly look at nearby surfaces, we increase near visual stress and the risk of developing myopia. As children grow, the use of their eyes will change the shape of the eyeball so that the muscles will have to contract less to keep the visual object into focus.  If the eyes predominantly look at near objects, books, cellphones, tablets, toys, and walls in a room where there is little opportunity to look at the far distance, the eye ball will elongate and the child will more likely become near sighted. Over the last thirty year and escalated during COVID’s reside-in-place policies, children spent more and more time indoors while looking at screens and nearby walls in their rooms. Predominantly focusing on nearby objects starts even earlier as parents provide screens to baby and toddlers to distract and entertain them. The constant near vision remodels the shape of eye and the child will  likely develop near sightedness.  

Health risks of sightedness and focusing predominantly upon nearby objects

  • Increased risk of get into an accident as we have reduced peripheral vision.  In earlier times if you were walking in jungle, you would not survive without being aware of your peripheral vision. Any small visual change could indicate the possible presence food or predator, friend or foe.  Now we focus predominantly centrally and are less aware of our periphery. Observe how your peripheral awareness decreases when you bring your nose to the screen to see more clearly.  When outside and focusing close up the risk of accidents (tripping, being hit by cars, bumping into people and objects) significantly increases as shown in figure 3 and illustrated in the video clip.

Pedestrian accidents (head forward with loss of peripheral vision)

Figure 3. Injuries caused by cell phone use per year since the introduction of the smartphone (graphic from Peper, Harvey and Faass,2020; data source: Povolatskly et al., 2020).

Source: https://media.giphy.com/media/308cQ2vXnA5X8Ou3jo/giphy.mp4
  • Myopia increases the risk of eye disorder. The risk for glaucoma, one the leading causes of blindness, is doubled (Susanna, De Moraes, Cioffi, & Ritch, R. 2015). The excessive tension around the eyes and ciliary muscles around the lens can interfere with the outflow of the excess fluids of the aqueous humour through the schlemm canal and may compromise the production of the aqueous humour fluid. These canals are complex vascular structures that maintains fluid pressure balance within the anterior segment of the eye. When the normal outflow is hindered it would contribute to elevated intraocular pressure and create high tension glaucoma (Andrés-Guerrero, García-Feijoo,  & Konstas, 2017).  Myopia also increases the risk for retinal detachment and tears, macular degeneration and cataract. (Williams & Hammond, 2019).

By learning to relax the muscles around the lens, eye and face and sensing a feeling of soft eyes, the restriction around the schlemm canals is reduced and the fluids can drain out easier and is one possible approach to reverse glaucoma (Dada et al., 2018; Peper, Pelletier & Tandy, 1979).

WHAT CAN YOU DO?

The solutions are remarkable simple. Respect your evolutionary background and allow your eyes to spontaneously alternate between looking at near and far objects while being upright (Schneider, 2016; Peper, 2021; Peper, Harvey & Faass, 2020).

For yourself and your child

  • Let children play outside so that they automatically look far and near.
  • When teaching children to read have them look at the distance at the end of every paragraph or page to relax the eyes.
  • Limit screen time and alternate with outdoor activities
  • Every 15 to 20 minutes take a vision break when reading or watching screens.  Get up, wiggle around, move your neck and shoulders, and look out the window at the far distance.
  • When looking at digital screens, look away every few minutes. As you look away, close your eyes for a moment and as you  are exhaling gently open your eyes.
  • Practice palming and relaxing the eyes. For detailed guidance and instruction see the YouTube video by Meir Schneider.

Create healthy eye programs in schools and work

  • Arrange 30 minute lesson plans and in between each lesson plan take a vision and movement breaks. Have children get up from their desks and move around.  If possible have them look out the window or go outside and describe the furthest object they can see such as the shape of clouds, roof line or details of the top of trees.
  • Teach young children as they are learning reading and math to look away at the distance after reading a paragraph or finishing a math problem.
  • Teach palming for children.
  • During recess have students play games that integrate coordination with vision such as ball games.
  • Episodically, have students close their eyes, breathe diaphragmatically and then as they exhale slowly open their eyes and look for a moment at the world with sleepy/dreamy eyes.
  • Whenever using screen use every opportunity to look away at the distance and for a moment close your eyes and relax your neck and shoulders.

BOOKS TO OPTIMIZE VISION AND TRANSFORM TECHSTRESS INTO TECHHEALTH

Vision for Life, Revised Edition: Ten Steps to Natural Eyesight Improvement by Meir Schneider.

TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics by Erik Peper, Richard Harvey and Nancy Faass   

YOUTUBE PRESENTATION, Transforming Tech Stress into Tech Health.

ADDITIONAL BLOGS THAT FOCUS ON RESOLVING EYES STREAN AND TECHSTRESS

REFERENCES

Andrés-Guerrero, V., García-Feijoo, J., & Konstas, A.G. (2017). Targeting Schlemm’s Canal in the Medical Therapy of Glaucoma: Current and Future Considerations. Adv Ther, 34(5), 1049-1069.

Bressler, N.M. (2020). Reducing the Progression of Myopia. JAMA, 324(6), 558–559.

Chen, S. J., Lu, P., Zhang, W. F., & Lu, J. H. (2012). High myopia as a risk factor in primary open angle glaucoma. International journal of ophthalmology5(6), 750–753.

Cordain, L.,  Eaton, S.B., Miller, J. B., Lindeberg, S., & Jensen, C. (2003). An evolutionary analysis of the aetiology and pathogenesis of juvenile‐onset myopia. Acta Ophthalmologica Scandinavica, 80(2), 125-135.

Dada, T., Mittal, D., Mohanty, K., Faiq, M.A., Bhat, M.A., Yadav, R.K., Sihota, R., Sidhu, T,, Velpandian, T., Kalaivani, M., Pandey, R.M., Gao, Y., Sabel, B,A., & Dada, R. (2018). Mindfulness Meditation Reduces Intraocular Pressure, Lowers Stress Biomarkers and Modulates Gene Expression in Glaucoma: A Randomized Controlled Trial. J Glaucoma, 27(12), 1061-1067.

Hansraj, K. K. (2014). Assessment of stresses in the cervical spine caused by posture and position of the head. Surgical Technology International, 25, 277–279.

Harvey, R., Peper, E., Booiman, A., Heredia Cedillo, A., & Villagomez, E. (2018). The effect of head and neck position on head rotation, cervical muscle tension and symptoms. Biofeedback. 46(3), 65–71.

Min, L.P. (2019). Speech by Dr. Lam Pin Min, Senior Minister of State for Health, Singapore, at the opening of the Sangapore National Eye Centre’s Myopia Center, 16 August, 2019.

Peper, E. (2021). Resolve eyestrain and screen fatigue. Well Being Journal, 30(1), 24-28.

Peper, E., Booiman, A., Lin, I.M., & Harvey, R. (2016). Increase strength and mood with posture. Biofeedback. 44(2), 66–72.

Peper, E., Harvey, R. & Faass, N. (2020). TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. Berkeley: North Atlantic Books.

Peper, E., Lin, I-M., Harvey, R., & Perez, J. (2017). How posture affects memory recall and mood.  Biofeedback.45 (2), 36-41.

Peper E., Pelletier K.R., Tandy B. (1979) Biofeedback Training: Holistic and Transpersonal Frontiers. In: Peper E., Ancoli S., Quinn M. (eds) Mind/Body Integration. Springer, Boston, MA.

Povolotskiy, R., Gupta, N., Leverant, A. B., Kandinov, A., & Paskhover, B. (2020). Head and Neck Injuries Associated With Cell Phone Use. JAMA Otolaryngology–Head & Neck Surgery, 146(2), 122-127.

Schneider, M. (2016). Vision for Life, Revised Edition: Ten Steps to Natural Eyesight Improvement. Berkeley, CA: North Atlantic Books.

Schneider, M. (2019). YouTube video Free Webinar by Meir Schneider: May 6, 2019.

Susanna, R., Jr, De Moraes, C. G., Cioffi, G. A., & Ritch, R. (2015). Why Do People (Still) Go Blind from Glaucoma?. Translational vision science & technology4(2), 1.

Williams, K., & Hammond, C. (2019). High myopia and its risks. Community eye health32(105), 5–6.


Configure your brain to learn and avoid Zoom fatigue [1]

Adapted from: Peper, E., Wilson, V., Martin, M., Rosegard, E., & Harvey, R. (2021). Avoid Zoom fatigue, be present and learn. NeuroRegulation, 8(1), 47–56. https://doi.org/10.15540/nr.8.1.47

After a while, it all seems the same.  Sitting and looking at the screen while working, taking classes, entertaining, streaming videos and socializing.  The longer I sit and watch screens, the more I tend to feel drained and passive, and the more challenging it is to be present, productive and pay attention.

Overnight, the pandemic transformed college teaching from in-person to online education. Zoom[2] became the preferred academic teaching and learning platform for synchronous education. Students and faculty now sat and looked at the screen for hours. While looking at the screen, the viewers were often distracted by events in their environment, notifications from smartphones, social media and email, which promoted multitasking (Solis, 2019).  The digital distractions causing people to respond to twice as many devices with half of our attention—a process labeled ‘semi-tasking’- meaning getting twice as much done half as well.

For many students synchronous online learning was more challenging, especially after teaching was shifted to a Zoom environment without adapting the course materials to optimize online learning. During polling of 325 undergraduate university students at a metropolitan university who were all taking synchronous online Zoom classes, the vast majority reported that learning was somewhat to extremely difficult, with only the minority of students (approximately 6%) preferring online learning as shown in Figure 1. 

Figure 1.  Survey of 325 Undergraduates comparing Zoom online learning compared to the previous in person classes. Approximately 94% had moderate to considerable difficulty with on line learning.

The increased self-report on difficulty experienced in synchronous Zoom online learning may also affect academic achievement.  At the same time, many people have reported an increase in physical, behavioral and psycho-emotional problems  (e.g. backache, headache, stomachache, eye-strain, sore neck and shoulder pain, over or under eating, over or under sleeping, over or under exercising, ruminative thoughts related to categories of anxiety/fear, boredom/numbness, depression/sadness, anger/hostility, etc) (Fosslien & Duffy, 2020; Lee, 2020; Intolo, 2019; Leeb et al, 2020; McGinty et al, 2020; Peper & Harvey, 2018; Peper, Harvey and Faas, 2020). 

This post explores factors that contribute to zoom fatigue and offers practical suggestions to optimize learning during synchronous Zoom online education. The concepts are derived from our teaching athletes to sustain peak mental and physical performance, with the implication that the same concepts can help students towards sustaining on-topic attention during online learning (Wilson & Peper, 2011). In sports, the coach can help guide the athlete; however, the athlete needs to be present and motivated.  Faculty have a responsibility to support, encourage, and engage students while students have the responsibility to configure themselves into an optimum learning state.

Part 1: Factors that contribute to Zoom fatigue

Differences in communication between live and computer communication

Until the 20th century, almost all communication included non-verbal expressions. The speaker used verbal and nonverbal expressions while the respondent would immediately show a reaction to the speaker.  There was a continuous dynamic verbal and nonverbal exchange. The listener would respond to the speaker. If they agreed they nodded their head.  If they disagreed or were intimidated they would provide alternative body movements (e.g., shake their head) or facial expressions (look away or frown).  During normal conversations, both the speaker’s facial expression and body language are noticed and responded to, which are in turn, can be used as feedback by the other person. In large group sessions with many participants, the visual feedback is reduced and facial responses are difficult to distinguish especially the gallery view. 

In a Zoom environment, both the sender and receiver are watching the computer screen without awareness that nonverbal cues are essential for the purpose of understanding not only what is being said but also for the implied meaning and its importance. These non-verbal cues are usually processed without awareness in live person-to-person exchange. While sending and receiving are usually simultaneous, there can exist a disconnect between the attached meanings of the encoded information and that of the decoded information due to the inconsistent existence of important nonverbal components.  In a Zoom environment, the end-result could mean multiple images of receivers providing the sender with little or no non-verbal cues with which to interpret the meaning they have attached to your message.  The person may appear to look at you; however, you do not know whether they are attending to you, have a neurological disorder and cannot respond, are reading their emails, watching YouTube videos, or texting on their phone. Additionally, the nonverbal cues they are sending may not be related to your message but to their reaction to other media, people or distractions not seen by the presenter. 

This mode of communication is different from communication patterns that evolved through natural selection and allowed the human species to thrive and survive. For the first time in human history we learn, teach, work, socialize, and entertain in front of the same screen.  In many cases, communication in the era of smartphones has been reduced to texting, writing digital responses or reacting to media content on any screen.  Over the past few decades, it is possible for people to communicate through more disembodied, off-topic and external modes of interaction. So many types of learning activities vie for our attention and can occur without leaving our chairs, thus, it may be difficult to stay on-topic online Zoom classes (Keller, Davidesco, & Tanner, 2020).

Normal communication typically involves whole body movements (face, head, arms and hands) which tends to energize or sometimes distract the speaker or listener (Kendon, 2004). When communicating with friends-we often move our bodies dynamically and responsively during the discussion.  With synchronous large online lectures, students tend to be passive and just sit and watch.[3] This state of sitting and just watching the screen is similar to watching video entertainment where we sit for a long time and are covertly conditioned not to act. 

Unknowingly, we have trained ourselves not to initiate action since the screen does not provide feedback to our responses- a process so different from talking and responding spontaneously in groups of participants.

When communication is safe, people interact, respond and chime in.  In large groups, just like large lectures, Zoom tends to inhibit this process because it delays social feedback since most people mute their microphone to avoid extraneous noise. This is usually the rule for large groups although for small groups, people often unmute themselves. The physical act of unmuting is an additional barrier to spontaneous verbal responses. This shift of attention induces a delay before responding.  From a communication perspective, a delay before responding reduces the spontaneity and is may be interpreted more negatively by the listener (Roberts, Margutti, & Takano, 2011).

Facial Expressions and Auditory Processing

Facial expressions are a critical part of non- verbal feedback and signals to the other person that they are being listened to and provide cues that the interaction is safe.  We unknowingly react to facial expressions–processed unconsciously through neuroception (Porges, 2017)–to indicate whether the person is signaling safety or danger.  Usually when the person is facially responsive and shows expression, it signals safety and allows communication and intimacy to be developed. If the person shows no facial expressions (a still/flat face), we unconsciously interpret this as a signal of danger (Porges, 2017). The importance of responsive feedback is illustrated in the study by Tronick et al (1975) where mothers were instructed not to respond with facial and body cues to their infant. The babies rapidly became highly disturbed when the mother stayed nonresponsive as dramatically illustrated in the YouTube video, Still Face Experiment: Dr. Edward Tronick (Tronick, 2007).  In adults lack of verbal and nonverbal feedback during social evaluations is extremely stressful (Gruenewald, Kemeny, Aziz, & Fahey, 2004; Birkett, 2011).

The absence of social facial and body feedback often makes teaching and learning more challenging.  Namely, are the receivers–the invisible, (only their picture or name is shown), partially visible (facial features are indistinct due to backlighting) or ghosting (those whose picture and name are shown but are physically absent from the session)–understanding the information the way the sender intended? 

Unlike traditional classroom settings where one has the benefit of seeing/sensing nonverbal cues, the Zoom gallery view often, the speaker may not know what how the audience is responding and this contributes to Zoom fatigue. In addition, the communication bond is often reduced when the speaker does not look at audience and the listener does not respond to the speaker with facial expressions.  Zoom fatigue can also be reduced when online teaching tools are used appropriately by involving active feedback responses through polls, chat, etc. as well as asking specific participants to speak and give feedback.

What is unique to the synchronous online environment is that the speakers and participants view themselves. This is the first time in human history that people are seeing themselves while speaking[4].   For some people, seeing themselves may increase anxiety and negative self-judgement- a process that is even more prevalent in teens.  Some are self-conscious and some have social anxiety and do not want their face to be shown (Degges-White, 2020).  In the past, most of us had no idea how we looked when others or ourselves are communicating—it is totally novel experience to see yourself while talking and communicating.

Reduced physical activity and increased near vision stress.

 Before sheltering in place, I would walk from my house to the BART station, take the train to Daly City station and then walk to the university.  At the university, I would climb stairs to go to my office, meet with other faculty and walk to the classroom.  At the end of the day, I would walk back to the Bart station and eventually walk home. Without any thinking or trying to do any exercise, I usually would do 12,000 steps and about 25 stairs.  Now, I am lucky if I do 3000 unless will myself to do more exercise.  –Erik Peper

The move to a Zoom environment and sheltering in place meant that we sit more and more which tends to increase mortality, decrease subjective energy and contributes to an attitude of passive engagement, more as an observer than as a participant (Stamtakis et al, 2019; Patel et al, 2018; Oswald et. al., 2020; Yalçin, Özkurt, Özmaden & Yagmur, 2020). While sitting, we also tend to slouch as we look at the screen that may be a covert factor in the increasing rates of depression and anxiety. 

This slouching position tends to decrease access to positive memories and allow easier access to negative memories (Peper et al, 2017) as well as interfere with academic performance.  Peper et al (2018) found that students have more difficulty performing mental math in the slouched as compared to upright sitting position. To reduce the impact of sitting, Peper & Lin (2012) found that when student perform some physical activities (e.g., skipping in place) for just a minute they report a significantly increase subjective energy and attention levels.

When looking at the screen our eyes only focus on the screen, which is different from in-person communication where you look at the person and then look at behind or to the side of the person. Only looking at the screen means that to focus on the screen the muscles of the eyes tighten so that the eyes can converge and the ciliary muscles around the lens contract so that the lens curvature is increased which results in near visual stress. This continuous looking at a near object is different from normal eye function in which we alternately focus on nearby objects and then look far away which allows the muscles of the eyes to relax.

Student Issues

Numerous students reported that it was much easier to be distracted and multitask, check Instagram, facebook, TikTok, or respond to emails and texts than during face-to-face classroom sessions as illustrated by two students’ comments.

“Now that we are forced to stay at home, it’s hard to find time by myself, for myself, time to study, and or time to get away. It’s easy to get distracted and go a bit stir-crazy.”

“I find that online learning is more difficult for me because it’s harder for me to stay concentrated all day just looking at the screen.” 

Students often reported that they had more difficulty remembering the materials presented during synchronous presentations. Most likely, the passivity while watching Zoom presentation affected the encoding and consolidation of new material into retrievable long term memory. The presented material was rapidly forgotten when the next screen image or advertisement appeared and competed with the course instructor for the student’s attention. We hypothesize that the many hours of watching TV and streaming videos have conditioned people to sit and take in information passively, while discouraging them to respond or initiate action (Mander, 1978; Mărchidan, 2019). Learning requires engagement, which means a shifting from passively watching and listening to being an active, participant shareholder in synchronous online classes.  However, in most cases, students have not received information/education or training on HOW TO be a more active/engaged participant in a synchronous Zoom class.

Instructor Issues

Instructors also have many of the same issues when presenting classes online. They engage in multiple simultaneous roles: presenter, director, and producer.  While teaching, they need to engage students, monitor the chat for feedback and look at the screen for facial responses.  At the same time, they may face similar technical issues as those experienced by students such as internet connectivity, limited bandwidth, and mastering the technical features of synchronous online learning technology.  At times, instructors feel that students expect each presentation to be as captivating as a TED talk.  Thus, teaching has shifted from education to edutainment

Part 2: Practical suggestions to optimize learning

To optimize learning in the synchronous online environment, teachers have the responsibility to reconfigure their teaching so that it incorporates active student involvement and students have the responsibility to be present and engaged. The following practices may facilitate learning:

Be present to learn

Mastering media presence is becoming even more important for everyone. The skill implemented in attending an online learning class will also be useful for professional development.  Although the pandemic shifted personal interviews to online interviews, most likely, synchronous and asynchronous video interviews are part of the first automatic screening level to assess candidates for a job (Rubinstein, 2020).

Be visible for the other person looking at you to create a positive impression

Adjust your camera and lights so that your face is visible and you are looking at the person to whom you are talking. Your screen presence is representing you.  Does the camera show you engaged or distracted lying on bed?  Be aware that you and your background together create an impression. The concept that looking directly at the audience– looking directly at the camera–is not new. Everyone working in media (newscasters, politicians, actors) have been trained to make their faces visible and expressive.  This means arranging your webcam at eye level right in front of you and speaking to the camera as if it is the person.  Avoid looking down at the person on the screen since the viewer would see you looking look down and away. Be sure your face is illuminated and there are no bright light sources behind you (Purdy, 2020).  We recommend that in small group, participants unmute their microphones so that people can respond spontaneously to each other unless there is excessive background noise.

Be a responsive and interactive listener to configure your brain to be engaged

Shift from being a passive absorber to an active participant even if your camera is off or the speaker cannot see you. Imagine being physically with the speaker and activate yourself by increasing your face and body animation as you are attending a synchronous online class.  Thus, when you watch a presentation, act as if you are in a personal conversation with the presenter or the material. This means that if you agree, nod your head; if you disagree, shake your head (do this naturally without making it a work task). Do this for the whole session.  Our research has shown that when college students purposely implement animated facial and body responses during Zoom classes, they report a significant increase in energy level, attention and involvement as compared to just attending normally in class (Peper & Yang, in press). See Figure 2.

Figure 2.  Change in subjective energy, attention and involvement when the students significantly increase their facial and body animation by 123 % as compared to their normal non-expressive class behavior (Peper & Yang, in press).

  “I never realized how my expressions affected my attention. Class was much more fun”

-22 year old woman student.

“I can see how paying attention and participation play a large role in learning material. After trying to give positive facial and body feedback I felt more focused and I was taking better notes and felt I was understanding the material a bit better.”-28 year old medical student

Configure your body to attend and perform

Sit upright and adapt a position of empowerment. When we sit upright and expanded it is easier to have positive thoughts and detach from negative hopeless thoughts (Peper, Lin, Harvey, & Perez, 2017; Peper, Harvey, Mason, & Lin, 2018). Students also performed better in mental math when they sat upright as compared to collapsed. When students are provided ongoing feedback when they begin to slouch by an app that uses the computer camera to monitor slouching, they reported a significant decrease in neck and back symptoms (Chetwynd et al, 2020). As one of many students reported:

“Before when I didn’t use the app, I had a lots of shoulder and neck pain. Now when I use it, the pain went way down as I kept changing posture to the feedback signal. I had more energy and I was more alert. I did notice that when I would get the alert to sit up straight.”

Optimize concentration and learning

In the online environment, the structure more likely depends upon the person unlike the externally created structure of going to work or to class. Thus, purposely creating a time structure and scheduled time-periods to perform different tasks as time management skills are associated with improved school and work performance (Macan et al., 1990).  Create an environment to promote concentration and reduce distractions.

  • Stay on task and reduce interruption and practice refocusing on task. On the average we now check our phones 96 times a day—that is once every 10 minutes and an increase of 20% as compared to two years ago (Asurion Research, 2019). Those who do media multitasking such as texting while doing a task perform significantly worse on memory tasks than those who are not multitasking (Madore et al., 2020). Multitasking is negatively correlated with school performance (Giunchiglia et al, 2018). When working or attending a class or meeting, turn off all notifications (e.g., email, texts and social media). Then block out specific times when you work on Zoom and when you respond to email, phone or social media (Newport, 2016). Let people know that you will look at the notifications and respond in a predetermined time so that you will not be interrupted while working or studying.  If you work where there are other people, arrange your workstation so that there are fewer distractions such as sitting with your back to other people. When students chose to implement a behavior change to monitor cellphone and media use and reduce the addictive behavior during a five-week self-healing project, many report a significant improvement of health and performance.  One student observed that when she reduced her cellphone use her stress level equally decreased as shown in Fig 3.

Figure 3. Example of a student changing cellphone use and corresponding decrease in subjective stress level.

During this class project, many students observed that the continuous responding to notifications and social media affect their health and productivity. As one student reported,

The discovery of the time I wasted giving into distractions was increasing my anxiety, increasing my depression and making me feel completely inadequate. In the five-week period, I cut my cell phone usage by over half, from 32.5 hours to exactly 15 hours and used some of the time to do an early morning run in the park. Rediscovering this time makes me feel like my possibilities are endless. I can go to work full time, take online night courses reaching towards my goal of a higher degree, plus complete all my homework, take care of the house and chores, cook all my meals, and add reading a book for fun!

                                                                              –22 year old College Student

  • Approached learning with a question. When you begin to study the material or attend a class, ask yourself questions that you would like to be answered. If possible, put your questions to the instructor. When you have a purpose, it is easier to stay emotionally present and remember the material (Osman, & Hannafin, 1994).
  • Take written notes while attending a Zoom meeting or class.  When participants take hand written notes versus on the computer they tend to integrate and remember the material much more than just watching passively (Mueller & Oppenheimer, 2014). Active note taking leads to focused attention and fewer distractions from social media content (Flanigan & Titsworth, 2020).
  • Review materials. At the end of the class, meet with your fellow students on ZOOM or social media and review the class materials.  As you discuss the materials, add comments to your notes and if possible, do a hierarchical outline to more easily remember the relationships among the ideas. 
  • Change your internal language. What we overtly or covertly say and believe is what we may become. When one says, “I am stupid”, “I can’t do math,” or “It is too difficult to learn,” one may become powerless which increases stress and inhibits cognitive function.  Instead, change the internal language so that it implies that you can master the materials such as, “I need more time to study and to practice the material,”  “Learning just takes time and at this moment it may take a bit longer than for someone else,” or “I need a better tutor.” 

Create an environment to trigger the appropriate mental and emotional state for learning.

Learning and recall are state dependent.  Without awareness, the learned content is covertly associated with environmental, emotional, social and kinesthetic cues.  Thus, when you study in bed, the material is more easily accessed while lying down. When you study with music, the music becomes a retrieval cue.  Without awareness, the materials are encoded with the cues of lying down or the music played in the background.  When you take your exam in a different setting then you have studied, none of the covert cues are there, thus, it is more difficult to recall the material. Study and review the materials under similar conditions, as you will be tested. 

To configure yourself to be ready to study, work, or socialize create different environments that are unique to each category of Zoom involvement (studying, working, socializing, entertaining). Pre COVID, we usually used different clothing for different events (work versus party) or different environments for different tasks (temple, churches, mosques, or synagogue for religious practice; bar or coffee shop to meet friends). Create a unique environment with each Zoom activity. The stimuli to be associated to the specific tasks can also include lighting, odors, sound or even drinks and food. These stimuli become the classically conditioned cues to evoke the appropriate response associated with the task just as Pavlov conditioned dogs to salivate by pairing a sound with the meat.  Taking charge of the conditioning process may help many people to focus on their task as so many students use their bedroom, kitchen or living room for Zoom work which is not always conducive for learning or work.

  • Wear task specific clothing just as you would have done going to work or school.  When you plan to study, put on your study T-shirt. In time, the moment you put on the study T-shirt, you are cueing yourself to focus on studying. When finishing with studying, change your clothing.
    • Arrange task specific backgrounds for each category of Zoom task. Place a different background such as a poster or wall hanging behind the computer screen-one for studying and another for entertainment. When finished with the specific Zoom event, take down the poster and change the background. 

Optimize arousal and regenerate vision

  • The longer we sit the more passive we tend to become. Teachers will benefit by interrupting the passive transfer of information by guiding students in fun short movements to increase arousal.  If instructors fail to put in movement breaks, students sitting in front of screens can remind themselves to move. The challenge is that we are usually unaware of how much time has passed as we are captured by the screen.  It is often helpful to use an app such as StretchBreak[5] to remind yourself to get up and move.
  • Get up and move every 30 minutes. After sitting for 30 minutes stretch, wiggle and move.  Do the movements with vigor or even dance, look up and reach up.  When you stand up and move your legs and feet, you tighten and relax your calf muscles that pump the venous blood and lymph fluids that have been pooling in your legs back to your heart. The calf muscle is often called the second heart because in facilitates venous blood return.
  • Regenerate vision. Our eyes tend to get tired and world looks blurry.  Interrupt the near vision stress by allowing the eyes to relax and regenerate.
  • Palming.  Bring your hands to your face and cup the hands so that there is no pressure on your eyeballs. Allow the base of the hands to touch the cheeks while the fingers are interlaced and resting your forehead. Then with your eyes closed imagine seeing black. Breathe slowly and diaphragmatically while feeling the warmth of the palm soothing the eyes. Feel your shoulders, head and eyes relaxing and do this for five minutes (Schneider, 2016; Peper, 2021).
  • Look at the distance.  Interrupt near visual stress (convergence of the eyes and tightening of the ciliary muscle around the lens allows us to focus on the screen) by looking away at the far distance.  Every so look at the clouds, top of trees or rooftops outside the window to relax the eyes.

Summary

By activating the evolutionary communication patterns that allowed us to survive and thrive and using known performance enhancement skills derived from peak performance training, we can enhance involvement and productivity. The instructor needs to stay current on methods that keep students attention. At the same time, students have a responsibility to configure themselves to optimize learning.   We recommend practices 1) to be present and learn, 2) optimize concentration and learning, 3) create an environment to trigger the appropriate mental and emotional state for learning, and 4) optimize arousal and regenerate vision.  By taking charge of your own teaching/learning process and configuring yourself to be present through active participation, learning is enhanced.

References

Asurion Research (November 19, 2019). Americans Check Their Phones 96 Times a Day. https://www.asurion.com/about/press-releases/americans-check-their-phones-96-times-a-day/#:~:text=Despite%20our%20attempts%20to%20curb,tech%20care%20company%20Asurion1.

Birkett M. A. (2011). The Trier Social Stress Test protocol for inducing psychological stress. Journal of visualized experiments: JoVE, (56), 3238. https://doi.org/10.3791/3238 

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Kendon, A. (2004). Gesture: Visible Action as Utterance. Cambridge, England: Cambridge University Press. https://www.amazon.com/Gesture-Visible-Action-as-Utterance/dp/0521542936/ref=sr_1_2?dchild=1&keywords=Gesture%3A+Visible+Action+as+Utterance.&qid=1617248925&s=books&sr=1-2

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Lemay, D.J., Doleck, T.,& Bazedlais, P. (2019). Self-determination, loneliness, fear of missing out, and academic performance. Knowledge Management & E-Learning: An International Journal, 11(4). https://doi.org/10.34105/j.kmel2019.11.025

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McGinty, E.E., Presskreischer, R., Anderson, K.E., Han, H., &Barry, C.L. (2020). Psychological distress and COVID-19–related stressors reported in a longitudinal cohort of US adults in April and July 2020. JAMA, 324(24), 2555-2557.  https://doi.org/10.1001/jama.2020.21231

Mueller, P.A. & Oppenheimer, D.M. (2014). The Pen Is Mightier Than the Keyboard: Advantages of Longhand Over Laptop Note Taking. Psychological Science, 25(6) 1159–1168. https://doi.org/10.1177/0956797614524581

Newport, C. (2016). Deep Work: Rules for Focused Success in a Distracted World. New York:Grand Central Publishing. https://www.amazon.com/Deep-Work-Focused-Success-Distracted/dp/1455586692/ref=sr_1_3?dchild=1&keywords=Deep+Work%3A+Rules+for+Focused+Success+in+a+Distracted+World&qid=1617249879&s=books&sr=1-3

Osman, M.E. & Hannafin, M.J. (1994). Effects of Advance Questioning and Prior Knowledge on Science Learning, The Journal of Education Research, 88(1), 5-13. https://doi.org/10.1080/00220671.1994.9944829

Oswald, T.K., Rumbold, A.R., Kedzior, S/G.E., & Moore, V.M. (2020) Psychological impacts of “screen time” and “green time” for children and adolescents: A systematic scoping review. PLoS ONE, 15(9), e0237725. https://doi.org/10.1371/journal.pone.0237725

Patel, A.V., Maliniak, M.L., Rees-Punia, E.R., Matthews, C.E., & Gapstur, S.M. (2018). Prolonged leisure time spent sitting in relation to cause-specific mortality in a large US cohort. American Journal of Epidemiology, 187(10), 2151–2158, https://doi.org/10.1093/aje/kwy125

Peper, E. (2021). Resolve Eyestrain and Screen Fatigue. Well Being Journal, 30, 24-28. https://www.researchgate.net/publication/345123096_Resolve_Eyestrain_and_Screen_Fatigue

Peper, E. & Harvey, R. (2018). Digital addiction: increased loneliness, depression, and anxiety. NeuroRegulation5(1),3–8 http://dx.doi.org/10.15540/nr.5.1.3

Peper, E., Harvey, R., & Faass, N. (2020). TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics.  Berkeley, CA: North Atlantic Books. https://www.penguinrandomhouse.com/books/232119/tech-stress-by-erik-peper-phd/ 

Peper, E., Harvey, R., Mason, L., & Lin, I.-M. (2018). Do better in math: How your body posture may change stereotype threat response. NeuroRegulation, 5(2), 67–74. http://dx.doi.org/10.15540/nr.5.2.67

Peper, E. & Lin, I-M. (2012). Increase or decrease depression-How body postures influence your energy level.  Biofeedback, 40 (3), 126-130. https://doi.org/10.5298/1081-5937-40.3.01

Peper, E., Lin, I-M., Harvey, R., & Perez, J. (2017). How posture affects memory recall and mood.  Biofeedback, 45 (2), 36-41. https://doi.org/10.5298/1081-5937-45.2.01

Peper, E. & Yang, A. (in press). Beyond Zoom Fatigue: Re-energize yourself and improve learning. Academia Letters. Adapted as a blog, Beyond zoom fatigue: Re-energize yourself and improve learning.

Porges, S.W. (2017). The pocket guide to the polyvagal theory: The transformative power of feeling safe. New York: W. W. Norton & Co. https://www.amazon.com/Pocket-Guide-Polyvagal-Theory-Transformative/dp/0393707873/ref=sr_1_2?dchild=1&keywords=The+pocket+guide+to+the+polyvagal+theory%3A+The+transformative+power+of+feeling+safe&qid=1617249068&s=books&sr=1-2

Purdy, K. (April 21, 2020).  How to Pull Off a Professional Video Call From Home. New York Times Wirecutter. https://www.nytimes.com/wirecutter/blog/professional-video-call-from-home/

Roberts F., Margutti P., Takano S. (2011). Judgments concerning the valence of inter-turn silence across speakers of American English, Italian, and Japanese. Discourse Process. 48,  331–354.  https://doi.org/10.1080/0163853X.2011.558002

Rubinstein, P. (2020). Asynchronous video interviews: The tools you need to succeed. 5th November 2020 https://www.bbc.com/worklife/article/20201102-asynchronous-video-interviews-the-tools-you-need-to-succeed

Schneider, M (2016). Vision for Life, Revised Edition: Ten Steps to Natural Eyesight Improvement. Berkeley, CA: North Atlantic Books. https://www.amazon.com/Vision-Life-Revised-Eyesight-Improvement/dp/1623170087/ref=sr_1_1?dchild=1&keywords=Vision+for+Life%2C+Revised+Edition%3A+Ten+Steps+to+Natural+Eyesight+Improvement&qid=1617250077&s=books&sr=1-1

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Tronick, E., Adamson, L.B., Als, H., & Brazelton, T.B. (1975, April). Infant emotions in normal and pertubated interactions. Paper presented at the biennial meeting of the Society for Research in Child Development, Denver, CO.

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[1] We thank Professor Jackson Wilson for his incisive comments.

[2] In this paper will use Zoom as the example for synchronous online teaching although the concepts may apply equally to other platforms such Microsoft Teams and Google Meet.

[3] Zoom and other synchronous online platforms provide tools to indicate that you would like to speak (e.g., electronic hand raising); however, it is an issue of how the class session is designed (e.g., do you use breakout rooms, are there structured requests for interaction). 

[4] Zoom has a feature to hide yourself. Start or join a Zoom meeting. The meeting automatically begins in Speaker View and you can see your own video. Then, right-click your video to display the menu, then choose Hide Myself.


Tips to Reduce Zoom Fatigue

Adapted from the book, TechStress: How Technology
is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics
, by Erik Peper, Richard Harvey and Nancy Faass.

Peper, E., Harvey, R., & Faass, N. (2020), TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics. Berkeley, CA: North Atlantic Books.


Breaking the social bond: The immobilized face

After teaching for hours on Zoom, I feel exhausted. Zoom fatigue is real.

While talking to a close friend, all of a sudden his attention shifted from listening to me to looking his cellphone as he heard a notification.  At that moment, I felt slightly left and hurt.

Students report that when they are are talking with friends and their friends look at their cellphone or responds to a notification they feel hurt and slightly dismissed. Even though most experience this break in social bonding, almost all do this with others. The looking at the phone is the conditioned stimuli to which we automatically respond when we feel it vibrate or even when we see it.  We respond by shifting our attention to the phone in the same way that Pavlov’s dogs would salivate when they heard the bell that was conditioned with the food.  On the average we now check our phones 96 times a day—that is once every 10 minutes and an increase of 20% as compared to two years ago (Asurion Research, 2019).

To feel SAFE is essential for growth and developing intimacy.  We interpret being safe through the process of neuroception.  Without conscious awareness our brain processes facial cues to identify if the interactions are safe or not safe.  If safe, vigilance and sympathetic arousal is reduced and better communication is supported (Porges, 2017). On the other hand, if a person’s face is flat and non-responsive during a conversation, it may signal danger and trigger fight/flight in the person seeing the non-reactive face. This unconscious stress reaction to a non-responsive face is the basis of the Tier Social Stress Test.  In this stress assessment, participants are asked to give a presentation and are also given an unexpected mental arithmetic test  in front of an panel of judges who do not provide any feedback or encouragement (Allen et al, 2016)). Not receiving social feedback while communicating is one of the most stressful events –it is being stuck in social quicksand as there are no cues to know what is going on.

We wonder if the absence of confirmative facial feedback is a component of Zoom fatigue when presenting to a larger group in which you see multiple faces as small postage stamps or no face at all.  In those cases, the screen does not provide enough covert facial and body feedback to know what is going on as you are communicating.  The audience non-responsive faces may covertly signal DANGER, The decrease visual and auditory signals is compounded by:

  • Technical issues due to signal bandwidth and microphone (freezing of the screen, pixilation of the display, breakup in sound, warbling of voice, etc.).
  • Viewers sitting still and facially immobilized without reacting as they watch and listen.
  • Time delay caused by participants turning on the microphone before speaking may be negatively evaluated by the listener (Roberts, Margutti, & Takano, 2011).
  • Non-recognizable faces because the face and upper torso are not illuminated and blacked out by backlighting or glare.
  • Lack of eye and face contact because the speaker or participant is looking at the screen and their camera is to the side, below or above their face.
  • Multi-tasking by the speaker who simultaneously presents and monitors and controls the Zoom controls such as chat or screen share.

In normal communication, nonverbal components comprise a significant part of the communication (Lapakko, 2007; Kendon, 2004).  We use many nonverbal cues (lip, eye, face, arm, trunk, leg and breathing movements) as well as olfactory cues to understand the message. In most group zoom meeting we only see the face and shoulders instead of an integrated somatic body response in a three-dimensional space as we look near and far. On the other hand, in front of the computer, we tend to sit immobilized and solely look at a two-dimensional screen at a fixed distance.  As we look at the screen we may not process the evolutionary nonverbal communication patterns that indicate safety. Similarly, when child does not receive feedback as it reaches out, it often becomes more demanding or withdraws as the social bond is disconnected.  

Parents captured by their cell phone while their child is demanding attention. 
From: https://live.staticflickr.com/3724/11180721716_1baa040430_b.jpg

Communication is an interactive process that supports growth and development. When the child or a person reaches out and there is no response. The detrimental effect of interrupting facial responsiveness is demonstrated by the research of University of Massachusetts’s Distinguished University Professor of Psychology Edward Tronick (Goldman, 2010; Tronick et al, 1975).

How to maintain build social bonds

Recognize that being distracted by cellphone notifications and not being present are emotional bond breakers, thus implement behaviors that build social connections.

Zoom recommendations

  • Arrange your camera so that your face and upper torso is very visible, there is no backlight and glare, and you are looking straight at the camera.
  • Provide dynamic visual feedback by exaggerating your responses (nod your head for agreement or shake your head no for disagreement).
  • When presenting, have a collaborator monitor Chat and if possible have them shift back and forth between share screen and speaker view so that the speaker can focus on the presentation.
  • Use a separate microphone to improve sound.
  • If the screen freezes or the sound warbles often an indication of insufficient bandwidth, turn off the video to improve the sound quality.

Social bonding recommendations

  • Share with your friends that you feel dismissed when they interrupt your conversation to check their cell phone.
  • When meeting friends, turn off the cell phone or put them away in another room so not to be distracted.
  • Schedule digital free time with your children.
  • During meal times, turn off cell phones or put them in another room.
  • Attend to the baby or child instead of your cellphone screen.

For a detailed perspective how technology impacts our lives and what you can do about it, see our book, TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics (Peper, Harvey, & Faass, 2020).  Available from: https://www.penguinrandomhouse.com/books/232119/tech-stress-by-erik-peper-phd/ 

References:

Allen, A. P., Kennedy, P. J., Dockray, S., Cryan, J. F., Dinan, T. G., & Clarke, G. (2016). The Trier Social Stress Test: Principles and practice. Neurobiology of stress6, 113–126.

Asurion Research (November 19, 2019).Americans Check Their Phones 96 Times a Day.

Goldman, J.G. (2010). Ed Tronick and the “Still Face Experiment.” Scientific American, Oct 18.

Kendon, A. (2004). Gesture: Visible Action as Utterance. Cambridge, England: Cambridge University Press  ISBN-13 : 978-0521835251 

Lapakko, D. (2007). Communication is 93% Nonverbal: An Urban Legend Proliferates. Communication and Theater Association of Minnesota Journal, 34, 7-19.

Peper, E., Harvey, R., & Faass, N. (2020). TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics.  Berkeley, CA: North Atlantic Books. ISBN-13: 978-1583947685 

Porges, S.W. (2017). The pocket guide to the polyvagal theory: The transformative power of feeling safe. New York: W. W. Norton & Co. ISBN-13 : 978-0393707878 

Roberts F., Margutti P., Takano S. (2011). Judgments concerning the valence of inter-turn silence across speakers of American English, Italian, and Japanese. Discourse Process. 48 331–354. 10.1080/0163853X.2011.558002 

Tronick, E., Adamson, L.B., Als, H., & Brazelton, T.B. (1975, April). Infant emotions in normal and pertubated interactions. Paper presented at the biennial meeting of the Society for Research in Child Development, Denver, CO.

 

 

 

 


Inna Khazan, PhD, interviews the authors of TechStress

Go behind the screen and watch Inna Khazan, PhD, faculty member at Harvard Medical School and author of Biofeedback and mindfulness in everyday life: Practical solutions for improving your health and performance, interview Erik Peper, PhD and Richard Harvey, PhD. coauthors of the new book, TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics. 

Dr. Inna Khazan interviews Dr. Erik Peper about his new book Tech Stress. We talk about some of the ways in which technology overuse affects our health and what we can do about it.

Dr. Inna Khazan interviews Dr. Rick Harvey about his new book Tech Stress, the way technology overuse can affect adults and children, and what we can do about it.


Why do I have neck and shoulder discomfort at the computer?

Adapted from the upcoming book, TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics, by Erik Peper, Richard Harvey and Nancy Faass.shoulder pain

While working in front of screens, many of us suffer from Zoom/screen fatigue, iNeck, shoulder and back discomfort, tired eyes, exhaustion and screen addiction (Peper, 2020; Fosslien & Duffy, 2020; So, Cheng & Szeto, 2017; Peper & Harvey, 2018). As we work, our shoulders and forearms tense and we are often not aware of this until someone mentions it. Many accept the discomfort and pain as the cost of doing work–not realizing that it may be possible to work without pain.

Observe how you and coworkers work at the computer, laptop or cellphone. Often we bring our noses close to the screen in order to the text more clearly and raise our shoulders when we perform data entry and use the mouse. This unaware muscle tension can be identified with physiological recording of the muscles electrical activity when they contract (electromyography) (Peper & Gibney, 2006; Peper, Harvey & Tylova, 2006). In most cases, when we rest our hands on our laps the muscle tension is low but the moment we even rest our hands on the keyboard or when we begin to type or mouse, our muscles may tighten, as shown in Figure 1. The muscle activity will also depend on the person’s stress level, ergonomic arrangement and posture.

EMGFigure 1. Muscle tension from the shoulder and forearm increased without any awareness when the person rested their hands on the keyboard (Rest Keyboard) and during typing and mousing. The muscles only relaxed when the hands were resting on their lap (Rest Lap) (reproduced by permission from Peper, Harvey, and Faass, 2020).

Stop reading from your screen and relax your shoulders.  Did you feel them slightly drop and relax?

If you experienced this release of tension and relaxation in the shoulders, then you were tightening your shoulders muscles without awareness. It is usually by the end of the day that we experience stiffness and discomfort. Do the following exercise as guided by the video or described in the text below to experience how discomfort and pain develop by maintaining low-level muscle tension.

While sitting, lift your right knee two inches up so that the foot is about two inches away from the floor. Keep holding the knee up in this position. Did you notice your breathing stopped when you lifted your knee? Are you noticing increasing tension and discomfort or even pain?  How much longer can you lift the knee up?

Let go, relax and observe how the discomfort dissipates.

Reasons for the discomfort

The discomfort occurred because your muscles were contracted, which inhibited the blood and lymph flow through the tissue. When your muscles contracted to lift your knee, the blood flow in those muscles was reduced. Only when your muscles relaxed could enough blood flow occur to deliver nutrients and oxygen as well as remove the waste products of metabolism (Wan et al, 2017). From a physiological perspective, muscles work most efficiently when they alternately contract and relax. For example, most people can walk without discomfort since their muscles contract and relax with each step.  However, you could  hold your knee up for a few minutes before experiencing discomfort in those same muscles.

How to prevent discomfort.

To prevent discomfort and optimize health, apply the same concept of alternating tensing and  relaxing to your neck, shoulder, back and arm muscles while working. Every few minutes move your arms and shoulders and let them relax. Interrupt the static sitting position with movement. If you need reminders to get up and move your body during the workday or long periods sitting in front of a device, you can download and install the free app, StretchBreak.

For more information, read and apply the concepts described in our upcoming book, TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. The book explains why TechStress develops, why digital addiction occurs, and what you can do to prevent discomfort, improve health and enhance performance. Order the book from Amazon and receive it August 25th. Alternatively,  sign up with the publisher and receive a 30% discount when the book is published August 25th. https://www.northatlanticbooks.com/shop/tech-stress/

book cover

References

Fosslien, L. & Duffy, M. W. (2020). How to combat Zoom fatigue. Harvard Business Review. April 29, 2020.

Peper, E. (2020). Resolve eye strain and screen fatigue. The peperperspective ideas on illness, health and well-being. Blog published June 29, 2020. 

Peper, E. & Gibney, K. H. (2006). Muscle Biofeedback at the Computer: A Manual to Prevent Repetitive Strain Injury (RSI) by Taking the Guesswork out of Assessment, Monitoring and Training. Amersfoort: The Netherlands: Biofeedback Foundation of Europe. ISBN 0-9781927-0-2. Free download of the the book: http://bfe.org/helping-clients-who-are-working-from-home/

Peper, E. & Harvey, R. (2018). Digital addiction: increased loneliness, depression, and anxiety. NeuroRegulation5(1),3–8

Peper, E., Harvey, R. & Faass, N. (2020). TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. Berkeley: North Atlantic Books.

Peper, E., Harvey, R. & Tylova, H. (2006). Stress protocol for assessing computer related disorders.  Biofeedback. 34(2), 57-62.

So, B.C.L., Cheng, A.S.K., & Szeto, G.P.Y. (2017). Cumulative IT use is associated with psychosial stress factors and musculoskeletal symptoms. Int. J. Environ. Res. Public Health 201714(12), 1541

Wan, J. J., Qin, Z., Wang, P. Y., Sun, Y., & Liu, X. (2017). Muscle fatigue: general understanding and treatment. Experimental & molecular medicine49(10), e384. https://doi.org/10.1038/emm.2017.194

 


Resolve Eyestrain and Screen Fatigue

Adapted from: Peper, E., Harvey, R. & Faass, N. (2020). TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. Berkeley: North Atlantic Books.

eyes
Forty percent of adults and eighty percent of teenagers report experiencing significant visual symptoms (eyestrain, blurry vision, dry eyes, headaches, and exhaustion) during and immediately after viewing electronic displays. These ‘technology-associated overuse’ symptoms are often labeled as digital eyestrain or computer vision syndrome (Rosenfield, 2016; Randolph & Cohn, 2017). Even our distant vision may be affected— after working in front of a screen for hours, the world looks blurry. At the same time, we may experience an increase in neck, shoulders and back discomfort. These symptoms increase as we spend more hours looking at computer screens, laptops, tablets, e-readers, gaming consoles, and cellphones for work, taking online classes, watching streaming videos for entertainment, and keeping connected with friends and family (Borhany et al, 2018; Turgut, 2018; Jensen et al, 2002).

Eye, head, neck, shoulder and back discomfort are partly the result of sitting too long in the same position and attending to the screen without taking short physical and vision breaks, moving our bodies and looking at far objects every 20 minutes or so.  The obvious question is, “Why do we stare at and are captured by, the screen?”  Two answers are typical: (1) we like the content of what is on the screen; and, (2) we feel compelled to watch the rapidly changing visual scenes.

From an evolutionary perspective, our sense of vision (and hearing) evolved to identify predators who were hunting us, or to search for prey so we could have a nice meal.  Attending to fast moving visual changes is linked to our survival.  We are unaware that our adaptive behaviors of attending to a visual or auditory signals activate the same physiological response patterns that were once successful for humans to survive–evading  predictors,  identifying food, and discriminating between friend or foe. The large and small screen (and speakers) with their attention grabbing content and notifications have become an evolutionary trap that may lead to a reduction in health and fitness (Peper, Harvey & Faass, 2020).

Near vision stress

To be able to see the screen, the eyes need to converge and accommodate. To converge,  the extraocular muscles of the eyes tighten; to focus (accomodation), the ciliary muscle around the lens tighten to increase the curvature of the lens.  This muscle tension is held constant as long as we look at the screen. Overuse of these muscles results is near vision stress that contributes to computer vision syndrome, development of myopia in younger people, and other technology-associated overuse syndromes (Sherwin et al, 2012; Enthoven et al, 2020).

Continually overworking the visual muscles related to convergences increases tension and contributes to eyestrain. While looking at the screen, the eye muscles seldom have the chance to relax.  To function effectively, muscles need to relax /regenerate after momentary tightening. For the eye muscles to relax, they need to look at the far distance– preferably objects green in color. As stated earlier, the process of  distant vision occurs by relaxing the extraocular muscles to allow the eyes to diverge along with relaxing the ciliary muscle to allow the lens to flatten.  In our digital age, where screen of all sizes are ubiquitous, distant vision is often limited to the nearby walls behind a screen or desk which results in keeping the focus on nearby objects and  maintaining muscular tension in the eyes.

As we evolved, we continuously alternated between between looking at the far distance and nearby areas for food sources as well as signals indicating danger. If we did not look close and far, we would not know if a predator was ready to attack us.  Today we tend to be captured by the screens.  Arguably, all media content is designed to capture our attention such as data entry tasks required for employment, streaming videos for entertainment, reading and answering emails, playing e-games, responding to text notifications, looking at Instagram and Snapchat photos and Tiktok videos, scanning Tweets and using social media accounts such as Facebook. We are unaware of the symptoms of visual stress until we experience symptoms. To illustrate the physiological process that covertly occurs during convergence and accommodation, do the following exercise.

Sit comfortably and lift your right knee a few inches up so that the foot is an inch above the floor.  Keep holding it in this position for a minute…. Now let go and relax your leg.

A minute might have seemed like  a very long time and you may have started to feel some discomfort in the muscles of your hip.  Most likely, you observed that when you held your knee up, you most likely held your breath and tightened your neck and back. Moreover, to do this for more than a few minutes would be very challenging. 

Lift your knee up again and notice the automatic patterns that are happening in your body. 

For muscles to regenerate they need momentary relaxation which allows blood flow and lymph flow to occur. By alternately tensing and relaxing muscles, they can work more easily for longer periods of time without experiencing fatigue and discomfort (e.g., we can hike for hours but can only lift our knee for a few minutes).

Solutions to relax the eyes and reduce eye strain 

  • Reestablish the healthy evolutionary pattern of alternately looking at far and near distances to reduce eyestrain, such as:
    • Look out through a window at a distant tree for a moment after reading an email or clicking link.
    • Look up and at the far distance each time you have finished reading a page or turn the page over.
  • Rest and regenerate your eyes with palming. While sitting upright, place a pillow or other supports under our elbows so that your hands can cover your closed eyes without tensing the neck and shoulders.palming
    • Cup the hands so that there is no pressure on your eyeballs, allow the base of the hands to touch the cheeks while the fingers are interlaced and resting your forehead.
    • Close your eyes, imagine seeing black. Breathe slowly and diaphragmatically while feeling the warmth of the palm soothing the eyes. Feel your shoulders, head and eyes relaxing. Palm for 5 minutes while breathing at about six breaths per minute through your nose.  Then stretch and go back to work.

Palming is one of the many practices that improves vision. For a comprehensive perspective and pragmatic exercises to reduce eye strain, maintain and improve vision, see the superb book by Meir Schneider, PhD., L.M.T., Vision for Life, Revised Edition: Ten Steps to Natural Eyesight Improvement.

Increased sympathetic arousal

Seeing the changing stimuli on the screen evokes visual attention and increases sympathetic arousal. In addition, many people automatically hold their breath when they see novel visual or hear auditory signals; since, they trigger a defense or orienting response. At the same time, without awareness,  we may tighten our neck and shoulder  muscles as we bring our nose literally to the screen.  As we attend and concentrate to see what is on the screen, our blinking rate decreases significantly.  From an evolutionary perspective, an unexpected movement in the periphery could be a snake, a predator, a friend or foe and the body responds by getting ready: freeze, fight or flight. We still react the same survival responses. Some of the physiological reactions that occur include:

  • Breath holding or shallow breathing. These often occur the moment we receive a text notification, begin concentrating and respond to the messages, or start typing or mousing.  Without awareness,  we activate the freeze, flight and fight response. By breath holding or shallow breathing, we reduce or limit our body movements, effectively becoming a non-moving object that is more difficult to see by many animal predators.  In addition, during breath holding, hearing become more acute because breathing noises are effectively reduced or eliminated.
  • Inhibition of blinking. When we blink it is another movement signal that in earlier times could give away our position. In addition, the moment we blink we become temporarily blind and cannot see what the predator could be doing next.
  • Increased neck, shoulder and back tension. The body is getting ready for a defensive fight or avoidance flight.

Experience some of these automatic physiological responses described above by doing the following two exercises.

Eye movement neck connection:  While sitting up and looking at the screen, place your fingers on the back of the neck on either side of the cervical spine just below the junction where the spine meets the skull.

neck

Feel the muscles of neck along the spine where they are attaching to the skull. Now quickly look to the extreme right and then to the extreme left with your eyes. Repeat looking back and forth with the eyes two or three times.

What did you observe?  Most likely, when you looked to the extreme right, you could feel the right neck muscles slightly tightening and when you looked the extreme left, the left neck muscles slightly tightening.  In addition, you may have held your breath when you looked back and forth.

Focus and neck connection:  While sitting up and looking at the screen, place your fingers on the back of the neck as you did before. Now focus intently on the smallest size print or graphic details on the screen.  Really focus and concentrate on it and look at all the details.

What did you observe?  Most likely, when you focused on the text, you brought your head slightly forward and closer to the screen, felt your neck muscles tighten,  and possibly held your breath or started to breathe shallowly.

As you concentrated, the automatic increase in arousal, along with the neck and shoulder tension and reduced blinking contributes to developing discomfort. This can become more pronounced after looking at screens to detailed figures, numerical data, characters and small images for hours (Peper, Harvey & Tylova, 2006; Peper & Harvey, 2008; Waderich et al, 2013).

Staying alert, scanning  and reacting to the images on a computer screen or notifications from text messages, can become exhausting. in the past, we scanned the landscape, looking for information that will help us survive (predators, food sources, friend or foe)  however today, we react to the changing visual stimuli on the screen. The computer display and notifications have become evolutionary traps since they evoke these previously adaptive response patterns that allowed us to survive.

The response patterns occur mostly without awareness until we experience discomfort. Fortunately, we  can become aware of our body’s reactions with physiological monitoring which makes the invisible visible as shown in the figure below (Peper, Harvey & Faass, 2020).

biofeedback

Representative physiological patterns that occur when working at a computer, laptop, tablet or cellphone are unnecessary neck and shoulder tension, shallow rapid breathing, and an increase in heart rate during data entry. Even when the person is resting their hands on the keyboard, forearm muscle tension, breathing and heart rate increased.

Moreover, muscle tension in the neck and shoulder region also increased, even when those muscles were not needed for data entry task.  Unfortunately, this unnecessary tension and shallow breathing contributes to exhaustion and discomfort (Peper, Harvey & Faass, 2020).

With biofeedback training, the person can learn to become aware and control these dysfunctional patterns and prevent discomfort (Peper & Gibney, 2006; Peper et, 2003).  However, without access to biofeedback monitoring, assume that you respond similarly while working. Thus, to prevent discomfort and improve health and performance, implement the following.

Finally, for a comprehensive overview based on an evolutionary perspective that explains why TechStress develops, why digital addiction occurs. and what can be done to prevent discomfort and improve health and performance, see our new book by Erik Peper, Richard Harvey and Nancy Faass, Tech Stress-How Technology is Hijack our Lives, Strategies for Coping and Pragmatic Ergonomics.

book cover

References

Borhany, T., Shahid, E., Siddique, W. A., & Ali, H. (2018). Musculoskeletal problems in frequent computer and internet users. Journal of family medicine and primary care7(2), 337–339. 

Enthoven, C. A., Tideman, W.L., Roel of Polling, R.J.,Yang-Huang, J., Raat, H., & Klaver, C.C.W. (2020). The impact of computer use on myopia development in childhood: The Generation R study. Preventtive Medicine, 132, 105988.

Jensen, C., Finsen, L., Sogaard, K & Christensen, H. (2002). Musculoskeletal symptoms and duration of computer and mouse use,  International Journal of Industrial Ergonomics, 30(4-5), 265-275.

Peper, E. & Gibney, K. (2006). Muscle Biofeedback at the Computer- A Manual to Prevent Repetitive Strain Injury (RSI) by Taking the Guesswork out of Assessment, Monitoring and Training. The Biofeedback Federation of Europe. Download free PDF version of the book:  http://bfe.org/helping-clients-who-are-working-from-home/

Peper, E. & Harvey, R. (2008). From technostress to technohealth.  Japanese Journal of Biofeedback Research, 35(2), 107-114.

Peper, E., Harvey, R. & Faass, N. (2020). TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. Berkeley: North Atlantic Books.

Peper, E., Harvey, R. & Tylova, H. (2006). Stress protocol for assessing computer related disorders.  Biofeedback. 34(2), 57-62. 

Peper, E., Wilson, V.S., Gibney, K.H., Huber, K., Harvey, R. & Shumay. (2003). The Integration of Electromyography (sEMG) at the Workstation:  Assessment, Treatment and Prevention of Repetitive Strain Injury (RSI). Applied Psychophysiology and Biofeedback, 28 (2), 167-182.

Randolph, S.A. & Cohn, A. (2017).  Computer vision syndrome. Workplace, Health and Safety, 65(7), 328.

Rosenfield, M. (2016). Computer vision syndrome (a.k.a. digital eye strain). Optometry in Practice, 17(1), 1 1 – 10. 

Schneider, M. (2016). Vision for Life, Revised Edition: Ten Steps to Natural Eyesight Improvement. Berkeley: North Atlantic Books. https://self-healing.org/shop/books/vision-for-life-2nd-ed

Sherwin, J.C., Reacher, M.H., Keogh, R. H., Khawaja, A. P., Mackey, D.A.,& Foster, P. J. (2012). The association between time spent outdoors and myopia in children and adolescents. Ophthalmology,119(10), 2141-2151.

Turgut, B. (2018). Ocular Ergonomics for the Computer Vision Syndrome. Journal Eye and Vision, 1(2).

Waderich, K., Peper, E., Harvey, R., & Sara Sutter. (2013). The psychophysiology of contemporary information technologies-Tablets and smart phones can be a pain in the neck. Presented at the 44st Annual Meeting of the Association for Applied Psychophysiology and Biofeedback. Portland, OR.

 

 


Reduce TechStress at Home

Adapted from the book, Peper, E., Harvey, R., & Faass, (2020). Tech Stress: How Technology Is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. Berkeley: North Atlantic Books.

fig 1 extended neck

Numerous people report that working at the computer at home is more tiring than working in the office.  Although there are obvious advantages to working at home, there are also disadvantages (e.g., no space to work, challenging ergonomics, no escape from the family, lack of nonverbal cues used to communicate, less informal sharing at the water cooler, increased multitasking by working and having to take care of the children).

A major challenge is having a comfortable work space in your home.  This may mean finding a place to put the computer, keyboard and screen.  For some it is the kitchen table, desk in the corner of the bedroom, or coffee table while other it is in a totally separate room.

Incorrect ergonomic arrangement and stressed work style often increases neck, shoulder discomfort and aggravates eye strain and tiredness. Regardless how your digital work space is organized, implement the following life and work style suggestions and ergonomics recommendations to promote health.

LIFE AND WORK STYLE SUGGESTIONS

Take many, many, many breaks.  Movement breaks will reduce the covert static tension that builds up as we sit in static positions and work at the computer.

  • Every few minutes take a small break such as stand up and wiggle or role your shoulders. When performing the movements, stop looking at the screen and look around the room or out the window.
  • Every 30 minutes get up walk around for and move your body. Use timers to notify you every 30 minutes to take a break (e.g., cellphone alarms or personal digital assistants such as Hey Google, Siri, or Alexa).

Improve vision.

  • Take vision breaks to reduce eye fatigue.
    • Every few minutes look away from the screen and into the far distance and blink. If at all possible look outside at green plants which relaxes the near vision induced tension.
    • Blink and blink again. When working at the computer we reduce our blinking rate. Thus, blink each time you click on a new link, finishing entering a column of numbers, etc.
    • Close your eyes by letting the eye lids drop down as you also relax your jaw. Imagine a hook on top of your head which is pulling your head upward and at the same time drop your shoulders.
  • Reduce glare and bright backgrounds
    • Arrange your computer screen at 90 degrees to the brightest light source.
    • Have a darker background behind you when participating in video conferencing (e.g., Zoom, Skype, GoToMeeting, WhatsApp, FaceTime). Your face will be visible.

Regenerate

  • When stressed remember to breathe. As you inhale let your stomach expand as you exhale let the air flow out slowly.
  • Stop watching and listening to the negative news (check the news no more than once a day). Watch positive and humorous movies.
  • Get fresh air, go for a walk, and be in the sun
  • Reconnect with friends and share positive experiences.
  • Remind yourself, that this too shall pass.

ERGONOMIC RECOMMENDATIONS: MAKE THE WORLD YOURS

Good ergonomics means adapting the equipment and environment to you and not the other way around. Optimizes the arrangement of the chair, desk, keyboard, mouse, camera, screen and yourself as shown in Figure 1.

Workstation-Setup1

Figure 1. Recommended arrangement for working at the computer.

Arrange the laptop

The laptop is challenging because if your hands are at the right height for data entry on the keyboard, then you must look down to see the screen.  If the screen at the right height, then you have to raise your hands to reach the keyboard. There are two solutions for this challenge.

  1. Use an external keyboard and mouse, then raise the laptop so that the top of the screen is at eye level. Use a laptop stand or a stack of books to raise the lap top.
  2. Use an external monitor for display, then use the laptop as your keyboard.

If these solutions are not possible, take many, many, many breaks to reduce the neck and shoulder stress.

Arrange the computer workstation

  1. Adjust the chair so that your forearms can rest on the table without raising your shoulders. This may mean sitting on a pillow. If the chair is then too high and your legs dangle, create a foot stool on which you can rest your feet.
  2. Adjust the monitor so that the top of the screen is at eye level. If the monitor is too low, raise it by putting some books underneath it.
  3. If possible, alternate standing and sitting while working.

RESOURCES

Book

Tech Stress: How Technology Is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics provides insight in how discomfort, symptoms and media addiction develops and what you can do about it.  It incorporates the role of evolutionary traps, how biofeedback makes the unaware aware, experiential physical and cognitive practices, and ergonomic recommendations to optimize health and productivity. A must book for anyone using digital devices. Peper, E., Harvey, R., & Faass, (2020). Tech Stress: How Technology Is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. Berkeley: North Atlantic Books.

Ergonomic suggestions for working at the computer and laptop.

https://peperperspective.com/2014/09/30/cartoon-ergonomics-for-working-at-the-computer-and-laptop/

https://peperperspective.com/2014/02/24/optimizing-ergonomics-adapt-the-world-to-you-and-not-the-other-way-around/

11 tips for working at home

https://www.bakkerelkhuizen.com/knowledge-center/11-productivity-tips-for-homeworkers/?utm_campaign=US+-+19+03+20&utm_source=Newsletter&utm_medium=email

How our digital world activates evolutionary response patterns.

https://peperperspective.com/2020/01/17/evolutionary-traps-how-screens-digital-notifications-and-gaming-software-exploits-fundamental-survival-mechanisms/

https://peperperspective.com/2018/02/10/digital-addiction/

How posture affects health

https://peperperspective.com/2019/07/01/dont-slouch-improves-health-with-posture-feedback/

https://peperperspective.com/2019/05/21/relieve-and-prevent-neck-stiffness-and-pain/

https://peperperspective.com/2017/11/28/posture-and-mood-implications-and-applications-to-health-and-therapy/

https://peperperspective.com/2019/01/23/head-position-it-matters/